MANAGEMENT OF COMBINED RENAL AND PANCREATIC TRAUMA

During a 15-year period we treated 38 patients with combined renal and pancreatic injuries (40 kidneys): 18 patients (19 kidneys) with renal contusion (89% from blunt trauma) and 20 with renal laceration or vas cular injuries (90% from penetrating trauma). All patients with renal contusion were managed conservatively without complication, despite ma jor pancreatic injury in a third. The 16 patients with significant ren al and pancreatic injuries were classified as a high risk group: 3 und erwent nephrectomy for vascular injuries that could not be repaired bu t all of the remaining kidneys were salvaged. Perinephric abscesses de veloped in 2 of these patients, for a major complication rate of 15%. No secondary nephrectomies were necessary, nor did urinary fistulas de velop. We conclude that significant renal injuries in patients with ma jor pancreatic injuries may be managed by renal repair with an increas ed but acceptable complication rate and that nephrectomy should be per formed only if the degree of renal injury precludes repair.